Individual
DR. JONATHAN CHRISTOPHER BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
60 MDG/SGGX, 101 BODIN CIR, TRAVIS AFB, CA 94535-1809
(707) 423-5105
Mailing address
60 MDG/SGGX, 101 BODIN CIR, TRAVIS AFB, CA 94535-1809
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
C203377
CA
Other
Enumeration date
02/24/2015
Last updated
08/14/2025
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